Int J Diabetes Dev Ctries. 2015 Oct;35(Suppl 1):S1-S71
RSSDI Clinical Practice Recommendations for Management of Type 2 Diabetes Mellitus, 2015 Madhu SV, Saboo B, Makkar BM, Reddy GC, Jana J, Panda JK, Singh S, Setty N, Rao PV, Chawla R, Sahay RK, Aravind SR, Banerjee S, Bajaj S, Kumar V, Panikar V. Int J Diabetes Dev Ctries Oct;35(Suppl 1):S1-S71 Diagnosis of Diabetes RSSDI 2015 Recommendations Terminologies Recommended care constitutes evidence-based care which is cost-effective interventions that should be made available to all people with diabetes with an aim of any health-care system to achieve this level of care Limited care is the lowest level of care that seeks to achieve the major objectives of diabetes management provided in health-care settings with very limited resources drugs, personnel, technologies and procedures Diagnosis of Diabetes: Recommended Care
Any of the following criteria can be used Fasting plasma glucose (FPG) 126mg/dL*or Oral glucose tolerance test (OGTT) using 75 gms of anhydrous glucose with FPG 126 mg/dl and/or 2 hour plasma glucose 200 mg/dL or Glycated hemoglobin (HbA1c) 6.5% **or (not suggested in Limited Care) Random plasma glucose 200 mg/dl in the presence of classical diabetes symptoms Asymptomatic individuals with a single abnormal test should have the test repeated to confirm the diagnosis unless the result is unequivocally abnormal *FPG is defined as glucose estimated after no caloric intake for at least 8-12 hours ** Using a method that is National Glycohemoglobin Standardization Programme (NGSP) certified. For more on HbA1c & NGSP, please visitasp Diagnosis of Diabetes: Note
Point of care device for estimation of HbA1c is not recommended for diagnosis Capillary glucose estimation methods are not recommended for diagnosis Venous Plasma is used for estimation of Blood glucose Plasma must be separated soon after collection because the blood glucose levels drop by 5-8% hourly if whole blood is stored at room temperature Screening/Early detection of Diabetes RSSDI 2015 Recommendations Screening/early detection of diabetes: Recommended care
Each health service should decide whether to have a program to detect people with undiagnosed diabetes This decision should be based on the prevalence of undiagnosed diabetes and available support from health-care system/service capable of effectively treating newly detected cases of diabetes Opportunistic screening for undiagnosed diabetes and prediabetes is recommended. These should include: Individuals presenting to health care settings for unrelated illness Family members of diabetic patients Antenatal care People over the age of 30 years should be encouraged for voluntary testing for diabetes) Community screening may be done wherever feasible Screening/early detection of diabetes: Recommended care
Detection programs should be usually based on a two-step approach: Step 1 - Identify high-risk individuals using a risk assessment questionnaire Indian Diabetes Risk Score (IDRS) is recommended for Indians. Step 2 - Glycemic measure in high-risk individuals The Indian Diabetes Risk Score (IDRS) Screening/early detection of diabetes: Recommended care
Where a random non-FPG level 100 mg/dL to 200 mg/dL is detected, FPG should be measured, or OGTT should be performed Use of HbA1c as a sole diagnostic test for screening for diabetes/prediabetes is not recommended People with screen-positive diabetes need diagnostic testing to confirm diagnosis while those with screen-negative to diabetes should be re-tested after 3 years Paramedical personnel such as nurses or other trained workers be included as a part of any basic diabetes care team Screening/early detection of diabetes: Limited care
Detection programs should be opportunistic and limited to high-risk individuals in very limited settings The principles for screening are as for Recommended care Diagnosis should be based on FPG or capillary plasma glucose if only point-of-care testing is available Using FPG alone for diagnosis has limitations as it is less sensitive than 2-hour plasma glucose in Indians to diagnose diabetes Obesity and diabetes RSSDI 2015 Recommendations Obesity and diabetes: Recommended care
Maintaining healthy lifestyle is recommended for management of metabolic syndrome. This includes: Moderate calorie restriction (to achieve a 510 percent loss of body weight in the first year) Moderate increase in physical activity Change in dietary composition People with type 2 diabetes should be initiated on exercise therapy, prescribing a combination of aerobic and muscle strengthening activities Obesity and diabetes: Recommended care
Pharmacotherapy for obese type 2 diabetes patients should be considered in addition to lifestyle changes in those with BMI>27kg/m2 without co-morbidity, or a BMI >25kg/m2 with co-morbidity Metformin should be first line drug for all type 2 diabetes patients Lipase inhibitors (Orlistat) may be used for inducing weight loss GLP-1 analogues (exenatide and liraglutide) and SGLT-2 inhibitors (Canagliflozin, Dapagliflozin) may be preferred as add-ons to Metformin in obese T2DM patients Surgical treatment (Bariatric surgery) is indicated in patients with BMI >32.5 kg/m2 with co-morbidity, and BMI >37.5 kg/m2 without co-morbidity Diet therapy RSSDI 2015 Recommendations Diet Therapy: Recommended care
High-carbohydrate diets with relatively large proportions of unrefined carbohydrate and fiber such as legumes, unprocessed vegetables and fruits are recommended. Brown rice is preferred to polished white rice Protein intake equivalent to at least 15% of daily total calories is recommended Intake of non-nutritive artificial sweeteners in moderate amounts may be considered Combining foods with high and low glycemic indices, such as adding fiber-rich foods to a meal or snack, improves the glycemic and lipaemic profiles Diet Therapy: Recommended care Diet in diabetes patients with established CVD
Total dietary salt intake should be reduced (